HEALTH ORGANIZATIONS' USE OF FACEBOOK FOR HEALTH ADVERTISING AND PROMOTION
Hyojung Park, Shelly Rodgers, and Jon Stemmle
ABSTRACT: The purpose of this study is to examine how health organizations use interactive features and social media channels on Facebook to manage their brand for advertising purposes. A content analysis of 1,760 wall comments on health organizations' Facebook pages reveals that nonprofit health organizations are more active in posting to Facebook than any other health organization examined. However, nonprofit health organizations do not take full advantage of interactive features or other social media channels. Government agencies and schools/universities exhibit the broadest use of interactive features; health care institutions appear more devoted to integrating social media channels with Facebook than the other types of organizations. Overall, health organizations strategically use branding and advertising techniques to manage their image and promote their brands. Still, there is room for improvement to take better advantage of various social media tools for consumer-generated advertising and viral marketing.
Social media websites such as Facebook, YouTube, and Twitter have become the most popular destinations on the Internet, with two out of three Americans using social media sites, which translates into 63.7% of U.S. Internet users, or about 147.8 million people (eMarketer 2011). Social media sites also serve as a growing source of health care information, and Facebook is the preferred source of health information for those who use social media sites for health purposes (Dolan 2011). The growing popularity of the Internet and the proliferation of social media websites provide opportunities to online health advertisers and marketers. A recent national survey by the Pew Research Center indicates that more than half of U.S. adults (57%) seek health information on the Internet and that onefifth use Facebook or other social media to receive updates about health issues (Fox and Jones 2009). Although the emergence of new media has made information seeking and sharing more convenient and satisfying (Fox and Jones 2009), low health literacy remains a major problem in the United States (Berkman et al. 2011). In these circumstances, it is necessary to analyze how health organizations use social media to promote public health and build their brand identities, as well as to identity strategies for improvement. Social media sites allow health organizations to engage in conversations with consumers through unique interactive features, such as sharing videos and photos, commenting on Facebook, or retweeting on Twitter. Although many studies attempt to understand interactivity as a key concept in Internet advertising (Downes and McMillan 2000), interactivity in the context of social media sites has received scant attention.
Interactive features and applications offered on social media sites, such as feedback mechanisms, news feeds, or quizzes, may enhance an organization's promotional and branding activities by entertaining visitors and encouraging their repeat use of an organization's social media site (Zarrella 2009). This scenario provides an opportunity to add to existing research on interactivity by identifying current uses of social media channels and interactive features by health organizations that aim to create and disseminate promotional messages about a health issue (Kamel Boulos and Wheeler 2007). Therefore, this study examines how health-related organizations make use of interactive features and social media channels on Facebook and identifies how health organizations use Facebook to manage their brand for advertising purposes. Specifically, we examine who, among health organizations, is using Facebook to promote health issues; what interactive features health organizations employ; which social media channels are used in conjunction with Facebook; and how health organizations use Facebook branding techniques to manage their social presence online. In addition, we identify and contrast five types of health organizations to determine whether there are differences in the interactive features used, social media channels selected, or branding techniques used in Facebook. A content analysis of 1,760 wall comments posted on the Facebook pages of health organizations provides a map of social media use for health communication. This descriptive study thereby provides a foundational basis for further investigations of social media marketing in health care and other fields. The results can be used for strategic
Journal of Interactive Advertising, Vol 12 No 1 (Fall 2011), pp. 62-77. © 2011 American Academy of Advertising, All rights reserved ISSN 1525-2019
we provide the rationale and framework for this descriptive study. and challenges associated with the adoption of and research on this popular medium in the health care sector. A common element of social media sites is that content is often created and shared by the users of the sites (Gangadharbatla 2011). For example. many corporations and organizations have turned their focus to incorporating social media elements into their marketing and promotion strategies and fostering two-way or multidirectional communication between brands and consumers (Burson-Marsteller 2010. and connectedness (Mayfield 2008).
The emergence of social media platforms also offers increased capabilities for interactive communication and information sharing online (Kaplan and Haenlein 2010). Of many social networking sites available on the Web. Facebook is the most popular. 2002). The participatory nature and instant feedback of social media add a degree of interactivity to online advertising and marketing by facilitating consumer control and involvement in content creation and dissemination (Trusov. Tuten 2008). with more than 750 million users and 30 billion pieces of content (web links. Social Media and Interactive Features: Definitions and Background Kaplan and Haenlein (2010. facilitate more participation from users of social media and encourage a discussion among users with relatively few access or content creation barriers (Mayfield 2008). 2008). As a virtual social media platform. Distinguishing features of social media include participation.0. and (3) view and traverse their list of connections and those made by others within the system" (boyd and Ellison 2008. we provide the method details. 211). 4). and a discussion. and improves consumers' self-management behaviors (Guendelman et al. followed by a review of literature that leads into three research questions. The interactive capabilities offered on Facebook also make virtual content-sharing activities easy for users and encourage target audiences to engage in viral marketing (Thackeray et al. p. Practically speaking.63
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communication planning and hypothesis generation. conversation. Health insurance companies also have begun providing health tips and advice and send marketing messages via Facebook in an effort to interact with customers to enhance the image of the insurance industry (Terry 2011). community. we focus on a specific group of users of social media: health organizations that use social media to promote health issues and build a brand presence in social media. The remainder of this article is organized as follows: We first define social media and interactivity and provide background information about health organizations' use of social media to fulfill advertising and marketing goals. For this study. This type of personal recommendation is effective in getting the attention of potential consumers and influencing attitudes toward an organization and its brands (Thackeray et
. Next. and build brand communities. Recognizing the power of social media marketing. notes. this study provides a guide for how health organizations can strategically integrate social media elements into their communication planning. opportunities. Feedback mechanisms. Interactivity refers to "the condition of communication in which simultaneous and continuous exchanges occur. p. cost-effective way for both profit and nonprofit sectors to communicate health information. an increasing number of health organizations have come up with Facebook health applications that allow users to keep track of their exercise and diet goals (Donohue 2009) and coordinate their exercise plans (Dugan 2010). and Pauwels 2009). Finally. and that allow the creation and exchange of User Generated Content. Facebook offers an easy. photo albums) shared each month (Facebook 2011). promote their products and services." Social networking sites in particular refer to "web-based services that allow individuals to (1) construct a public or semi-public profile within a bonded system. Interactivity enables social networking sites to facilitate consumers' understanding of health information (Nutbeam 2000). Such an understanding also enables an identification of key variables for follow-up studies that want to examine the effects of message features on psychological processes. increases word of mouth among interpersonal networks (Kalichman et al. 2002). and these exchanges carry a social. such as buttons or quizzes. (2) articulate a list of other users with whom they share a connection. 2009). Bucklin. With this interactive potential. p. blog posts. the health care community has also tapped into social media tactics as part of its communication planning (Chou et al. results. The variables identified can also help social media marketing managers compose effective metrics to evaluate their social media efforts and measure the success of their strategies. 61) define social media as "a group of Internet-based applications that build on the ideological and technological foundations of Web 2. openness. news stories. binding force" (Rafaeli and Sudweeks 1997. as well as provide insights into the uses.
what. because their bigger budgets and staff help them manage consumer conversations? The orientation of the organization also should affect its social media use: Those that view social media as part of a larger integrated health communications program presumably make greater use of features that pertain to their particular goal and
. we attempted to examine as many as possible to give a nearly comprehensive picture of the interactive features that health organizations use to create and disseminate messages related to health literacy. LITERATURE REVIEW Rationale and Framework for a Descriptive Study on Social Media To identify opportunities for social media and advertising theory. Its rising influence has led health professionals and health organizations to find new ways to communicate health information to the public and promote their health care services (Suggs 2006). As an interactive medium for health communication. why. we are interested in health
organizations' postings. it is possible. along with one "H" question: how. 2008). and pharmaceutical companies. without regard to causal or other hypotheses. Because this study is descriptive in nature. Grimes and Schulz (2002. due to their smaller budgets. when. To begin to understand how health organizations use Facebook. Thus. medical centers. health care planning. acquire. the Internet has changed the way people seek. As the most popular social networking site.64
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al. and their participation in Facebook and other social networking sites is intended to be part of a larger integrated strategic communications plan. which answers five basic "W" questions: who. Presumably. not the postings of individuals who post comments on their own behalf on their Facebook profiles. have been criticized for inferring causal relations that result in invalid conclusions or implications (Carlson 2008). which leads to the first research question: RQ1: Who are the health organizations on Facebook? Interactive Features In the next step. There is a difference between people who post comments on behalf of themselves and those who post comments on behalf of health organizations. and share information to manage their health (Rains 2007). The advent of social networking sites has advanced the interactive potential of the Internet by allowing ongoing. that different types of health organizations use different interactive features. to communicate effectively with a target audience and widely spread their messages through existing social networks. Within this framework. This approach bears similarities to Lasswell's comment on communication. we sought to understand what interactive features the health organizations use (RQ2) and which social media channels they select (RQ3). staff. because some descriptive studies. 145) recognize that descriptive studies are "concerned with and designed only to describe the existing distribution of variables. and resources? Or do business organizations use Facebook and its features to a greater degree. we begin by asking who is using Facebook to promote health issues-that is. Among the broad array of interactive features available on Facebook. such as government agencies. multifaceted conversations and introducing a wide array of interactive features (Hawn 2009. social media channels. and hypothesis generation (Grimes and Schulz 2002). Do nonprofit corporations employ Facebook for health advertising and promotion more than corporate health organizations. creating viral marketing opportunities for health organizations (Thackeray et al. and branding techniques to establish and maintain a brand presence. especially those that use content analysis as a method. we examine how health organizations use Facebook and its interactive features. health organizations have a strategic goal in mind. it is necessary to establish its importance in the broader advertising and interactive advertising literature. A common approach to descriptive studies is that of newspaper coverage. Facebook enables health organizations. we must understand who is represented among these organizations. health organizations that disseminate health advertising and promotional messages on their Facebook pages. Accordingly. Orsini 2010). p. Facebook is an ideal platform for facilitating brand awareness and promoting brand engagement. However. and even likely. Such interactive features can also encourage users to pass along health messages and share information about healthcare products. because its core consists of social networking and relationship building (Tuten 2008). 2008). which advertising scholars have used for decades: "Who says What in Which Channel to Whom with What Effects" (see Gangadharbatla 2011)." They often provide a springboard to more rigorous hypotheses about causal relations with comparison groups. and descriptive results can support trend analysis. and where (Grimes and Schulz 2002). These messages may take the form of promoting an event or directing traffic to view a new product or service on the organization's website.
and therefore. Health organizations similarly can adopt impression management strategies to produce positive organizational self-
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target audience. 2). a growing number of social media channels are available to users. makes it easy not only for health organizations to manage their messages. object. Thus. and Gibbs 2006). They also posted several videos about flu season safety tips and flu vaccine information on their YouTube sites. in the usage types of these health organizations? Branding and Self-Presentation on Social Media A core component of social networking sites is the public display of personalized user profiles and personal connections. In response to the outbreak of H1N1 in 2009. With their entertaining and informative value. in the usage types of these health organizations? Social Media Channels Because Facebook allows third-party developers to create compatible applications. This task is accomplished by referring back to the various social media channels the health organization utilizes. Heino. availability of vaccines. and Twitter. Organizations and individual users can take advantage of self-presentation tools offered by Facebook to enhance their images and broaden connections with other users (Trusov. Bucklin. With these communication efforts. and Ellison 2008). such as creating user profiles. different types of health organizations should use the social media channels differently. In the social media environment. whether Twitter. and mortality reports (National Association of County & City Health Officials 2009). Selfpresentational performances. YouTube. A recent real-life example illustrates how the integration of social media outlets can drive web traffic to an organization's social networking site. far more people joined one local health department's social networking pages. Users can construct such positive self-presentations using deliberately chosen photos or avatars (Wang et al. if any. or branding techniques available on Facebook. government health agencies and local health departments used Facebook and Twitter to provide up-to-date information. health organizations presumably integrate various social media platforms into their communication planning and align their social media activities. Effectively implementing various social media outlets may further contribute to increasing consumers' awareness of health-related products and services advertised by health organizations by accelerating the speed of shared information. or event by controlling or managing the exchange of information in social interaction" (Dwyer 2007. and audio/video materials but also for their Facebook visitors or fans to find needed information in various formats (Reed 2010). or Flickr. social media channels. To identify the interactive features being used. Again. as well as potential differences among types of health organizations. The use of social media channels creates an opportunity to facilitate the flow of health information by virtue of a dynamic and evolving ecology of networks across different social media platforms (Thackeray and Neiger 2009). we consider the following research question: RQ2: What interactive features do health organizations use on Facebook. Such crafted self-presentations enable users to strategically manage their interactions on social networking sites (Ellison. such as YouTube. and what differences are there. which often include personal information and photos or images. and those fans and followers acted as "information ambassadors" who disseminated more
information through their networks (National Association of County & City Health Officials 2009). Houghton. The integration of Facebook with other social media. Hancock. if any. are strategic activities designed to give good impressions to others (Goffman 1959). they are closely related to the notion of impression management on social networking sites. 2010). these social media channels and tools can increase the motivation of Facebook users to return to the site or generate intentions to continue creating and disseminating content (Newson. Impression management is "the goal-directed conscious or unconscious attempt to influence others' perceptions about a person. photos. and what differences are there. including flu clinic schedules. People select certain attributes to include in their profiles but exclude others to present themselves in a positive manner (Utz 2010). users engage in impression management when creating their profiles. Those that lack such a goal or that visit social media sites simply because it is a fad do not make as much use of the interactive features. Such deliberative behaviors affect the impressions viewers obtain when viewing personal web pages (Toma. which offers users a range of options for presenting highly selective versions of themselves and managing their images (boyd and Ellison 2008). To disseminate health messages more widely and attract greater viral attention. RQ3: Which social media channels do health organizations use on Facebook. and Patten 2009). and Pauwels 2009). Flickr.
similar analysis of Twitter also had identified multiple organizations. additional searches on Google used the key terms and "Facebook.90 indicate a fairly high and acceptable level of agreement among coders (Wimmer
. literacy). Using Holsti's (1969) formula. A total of 1. These search results were combined. Therefore. they appeared in the current sample. There is an abundance of health organizations on Facebook. and the coders practiced coding a subsample of wall comments until a satisfactory level of consensus was achieved. In this respect. The coders received several hours of training on the coding procedures.5% (n = 237) of the sample. and what differences are there. All comments posted by health literacy organizations thus were captured for the analysis (see Rodgers and Chen 2005). To ensure comprehensiveness." Comments containing the key terms and posted by health organizations in Facebook were traced back to business profiles. respectively. we searched Facebook and Twitter using the key terms. 2010. on health organizations' Facebook pages. intercoder reliability was calculated at . category definitions and detailed instructions were discussed. carried out the content analysis of the sampled wall comments. 2002). 2008 (first date on which an organization posted a comment). we sampled health organizations' Facebook pages. this study asks. Comments unrelated to health literacy were excluded from analysis. which may also provide an opportunity for the organizations to use viral marketing through word of mouth (Thackeray and Neiger 2009. an organization's brand identity is created through a profile (Scott 2011). The sampled comments were posted between May 8.1% (n = 1. in the usage types of these health organizations? METHOD Sampling Frame For this content analysis. An attractive identity on Facebook may lead visitors to "like" the organization's page and join its community (Tuten 2008). Bucklin. RQ4: How do health organizations use Facebook for impression management/branding purposes. N = 200) was double-coded to determine intercoder reliability. In the absence of an established sampling technique for social media. and July 13. This study used a census sample. two trained coders. The relatively complex
sampling technique consisted of multiple searches of databases and social media sites using the key term "health literacy" or some variation thereof (health and literacy. meaning that the sampling frame included all wall postings/comments on the identified health organizations' Facebook pages that met the sampling criteria. Before the actual coding was undertaken. Thorbjørnsen et al. and any duplicate organizations were deleted. By creating positive self-presentations in the social media environment. Scott 2011). and Pauwels 2009). an expert who has published extensively on sampling in mass media channels undertook a critique of the sampling technique in advance of the actual sampling. A previous. Health organizations could incorporate them as part of their promotional strategies. Building brand communities is an important step for an organization to increase brand awareness and enhance customer loyalty (Holland and Baker 2001. The final sample consisted of 35 organizations (see the Appendix). descriptive biographical information and using their logo as an avatar.91 on average. Values of Holsti's reliability coefficient above . because they reflect an organization's characteristics and serve as cues that enable visitors to determine if an organizational page fits their personal preferences and needs (Evans 2010. For example. if they were on Facebook. Specifically. Coding Procedure and Intercoder Reliability The unit of analysis was an individual wall posting. social networking sites such as Facebook can also serve as cost-effective and efficient advertising means. The two coders then coded 75. or comment. biographical information and photos are important components of branding. For example. pharmaceutical companies could increase awareness of new products and seek to improve attitudes toward their services. To avoid observation bias driven by a researcher's expectations. thereby achieving their promotional goals.760 wall comments were collected for the content analysis.4%. Thus. then separated health organizations from individual people posting messages about health. They may upload unique logos and create appealing profiles to attract more users. health organizations can generate good impressions and gain more users' attention. In virtual worlds. if any. Trusov.323) and 13. so we focused on those dealing with health literacy. During the initial training.66
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presentations and manage online impressions on Facebook. another subsample of comments (11. health organizations should create a profile that helps users learn about their affiliations by posting specific. which logically should be industry leaders in communicating easily understood health messages to other health organizations and the public. government health agencies might promote services or benefits and improve their credibility as public-serving organizations. other than the researchers.
the data appeared to be sufficiently reliable for analysis. Health care institutions. Schools or universities. Results of descriptive statistics show that March 2010 had the highest number of comments written by health organizations (n = 244). health organization). Nonprofit groups or organizations included public charitable organizations and private foundations. Flickr. Interactive features. The following descriptive variables were coded for categorization purposes: (1) date of the comment. such as photos and biographies (Scott 2010). plus an "other" category: comments/posts. The variable was coded at the nominal level. (2) type of access. instant messaging. (2) interactive features on Facebook. such as the Literacy Assistance Center and the Missouri Foundation for Health. photo. Type of health organization. blogging. coded to determine the visibility of the Facebook profile and wall posts. where yes = 1 or no = 0. or service offerings. and advertising goal. share. partially open. biographical advertisement. (3) social media channels used in combination with Facebook. Rodgers and Thorson 2009. product. Branding or advertising techniques refer to the use of features offered by the social media site that enable an organization to promote its brand. followed by April 2010 (n = 193) and February 2010 (n = 167) (see Figure 1). which receive donations or funds from individual members of the public. Thus.e. coded yes = 1 or no = 0. This variable was measured as an organization's integration of other social media sites with Facebook. Branding/advertising techniques. This variable was measured on a nominal scale. Six social media channels were coded: Twitter.e. There were 14 interactive features... e-mail updates. with a semi-public profile such that some parts were visible to anyone online. and other. Social media channels were defined as online platforms that enable members to produce.
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and Dominick 2006). e-games. such as the CDC or NIH. or collaborate on content across social networks (Tuten 2008).S. the coding scheme consisted of four parts: (1) basic descriptive information about the wall comments on Facebook and the Facebook user (i. Social media channels. with a public profile visible to anyone. e-cards. and (3) number of fans on the health organization's page. such as hospitals and medical centers. MySpace. widgets. Branding/advertising technique was operationally defined as whether an organization used features for self-presentation and promotion.or image-sharing. and closed. Corresponding to the research questions. where yes = 1 and no = 0. wall post advertisement. Social media channels was a nominal-level variable. Other. RESULTS Descriptive Statistics Date of comment. Department of Health and Human Services 2009). they were classified as separate categories in this study because their organizational objectives differed in terms of health promotion (Rodgers and Thorson 2009). Interactive features were defined in terms of their ability to facilitate simultaneous and constant sharing among participants of a given community. Business/corporations/pharmaceutical companies. e-mail. U. The type of access was a categorical level variable. but other parts were visible only to "friends". mobile/text messaging. links to bookmark the page. videosharing. The date was literally the date on which the comment was posted. Facebook also tracks the number of fans (i. Health organization type was defined in terms of the elements that made up the organization and its collective goal (see Rodgers and Thorson 2009). Coding Scheme The coding categories were developed on the basis of previous literature in health communication and media studies (Rodgers and Chen 2005. so the coders simply recorded the number of fans already indicated on the Facebook page. YouTube. according to three levels: open. RSS feed. This categorical-level variable had five main categories and an "other" category: Government centers or agencies. Community/advocacy/nonprofit groups. Descriptive variables. blogs.
Although government agencies and educational institutions may fall into the category of nonprofit organizations. with a private profile visible only to people who belong to that organization's network. and (4) Facebook features on selfpresentation/branding/advertising by the health organization. and e-mail newsletters. There were five branding techniques coded to indicate whether the organization included the following features on its page: logo. users who "like" the Facebook page). photo.
so it was dropped from further analysis. video-sharing (28.9%. or nonprofit organizations used RSS feeds.2%. n = 156). Blogging was used more frequently in the
comments of Facebook pages of government agencies (100%. the most frequent use was among government agencies (100%.
.5%. health care institutions (100%.664. N = 1760) = 117. Number of fans. and nonprofit organizations (n = 851). n = 286) than health business corporations (23. were more inclined to use video-sharing features than were the other health organization types (11.6%. n = 831). and e-newsletter (1. n = 496). For RSS feeds. By far. 3-713 for business corporations. The number of fans varied depending on the type of health organization. and health care institutions had 580 fans. These organizations used photosharing functions more frequently than health business corporations (87.726). n = 234). from 45-250 fans for schools and universities. followed by blogging (47. according to the type of health organization. There was no variation in this variable. such as hospitals (n = 163).7%. p < . and 1-467 for nonprofit organizations. n = 0 for health business corporations). n = 163).1%. n = 264) and schools/universities (77. and schools/universities (97. and health care institutions.68
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Type of access. the most common interactive feature was photosharing (98. n = 1.05). n = 0 for government agencies. All of the wall postings were published in an open format with a public profile visible to anyone online. n = 99 for nonprofit organizations.3%. Health care institutions. The government agencies had 40 fans.411.0%. health business corporations (n = 178). such as medical centers and hospitals (100%.1%. n = 18).
RESEARCH QUESTIONS In terms of who among health organizations is using Facebook for health literacy promotion. government centers or agencies (n = 264). Frequency of Wall Comments Posted per Month on Facebook by Health Organizations
The second research question sought to examine how health organizations use interactive features on Facebook (Table 1). n = 264). n = 41) and nonprofit organizations 2 (4. n = 227). N = 1760) = 1328. RSS feed (27.2%. health care institutions (n = 163). n = 164). The other totals varied. whereas none of the health care institutions. n = 163) and schools/universities (80. schools/universities (n = 292). The investigation of RQ2 also reveals differences among the interactive features used. Photo-sharing features were used by nearly all the government agencies (n = 264). p < . n = 491).9%. followed by schools or universities (n = 292). and the differences among the 2 (4.05).1%. health business corporations. e-mail (9. the descriptive results show that nearly half of the comments came from nonprofit organizations (n = 863).
and schools/universities (97.1%) 496 (28.0%) 851 (98.
In terms of social media channels (RQ3).9%) 18 (1.0%) 0 (0.0%) 0 (0.0%) 0 (0.6%) Business 178 (100.0%) 264 (15.0%) 163 (100.0%) Total 1760 (100.4%. Blogs were used more frequently by government agencies (100%. n = 2 (4. Government agencies did not use Twitter in any postings. A chi-square analysis reveals that social media channels differed among the five types of health organizations.5%) 77 (8.0%) 0 (0. Interactive Applications Used by Health Organizations
Health Organization Application Comments E-mail Photo-sharing Video-sharing Blogging RSS feed e-newsletter Total Government 264 (100. p < .69
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Table 1.9%. followed by blogs (47%.328* 1328.3%) 863 (49. N = 1760) = 330.1%) 1760 (100.1%) 286 (97.6%) 99 (11.0%) 0 (0.0%) 117.3%) 1726 (98.8%) 292 (100.0%) 0 (0.1%.0%) 0 (0.0%) 156 (87. and schools/universities (97.0%) 52 (17.0%.05).1%) Nonprofit 863 (100.9%.0%) 112 (13. n = 688).6%.0%) 163 (100. N = 1760) = 1341. health care institutions (100%.9%) 0 (0.3%) School 292 (100.4%.0%) 234 (80. n = 234) than by nonprofit organizations (33.05. p < . n = 715). p < . The sampled health organizations significantly 2 (4. health care institutions (100%. or nonprofit 2 (4. n = 73). Four degrees of freedom.0%) 41 (23.789* 2
Notes: The percentages in the cells are the column totals.1%. In contrast. n = 163).9%.05). so the numbers add up to 100% in each column.0%) 18 (2.411* 1508. n = 95).0%) 178 (10. n = 92) 2 (4. N = 1760) = 500.0%) 163 (100.455.7%. Flickr was not used by government agencies or health business corporations.0%) 0 (0. p < .0%) 164 (9. n = 1379). * p < .0%) 264 (100. n =264) . health business corporations (53.0%) 292 (16. Twitter was used more frequently by health care institutions (100%.0%) 163 (9.0%) Hospital 163 (100.724.
.05). YouTube was used more frequently by government agencies (100%.05).017. n = 286)
compared with health business corporations (51. n = 827).0%) 264 (100. n = 41). n = 163).2%) 831 (47. and Flickr (39. but not across the rows. Twitter (40.7%) 0 (0.9%) 227 (77.7%.664* 1097. n = 264). n = 175).450. n = 163) than by universities or schools (59. Flickr was used more frequently by health care institutions (100%. N = 1760) = 754. n = 163) and schools/universities (80.2%) 491 (27.6%) 0 (0. Table 2 shows that YouTube was used the most frequently by health organizations (78.0%) 0 (0. n = 286) than by health business corporations (23.0%) 264 (100.5%. and nonprofit organizations (8.
267.7%) 264 (15. n = 1.05).0%) Total 1550 (88. health care institutions (100%.1%) 450 (51.6%) Business 95 (53.065. and bio ads (4.017* 754. n = 766).2%.0%) 163 (100.5%.3%) 163 (9.0%) 106 (36.7%) 73 (8.0%) 163 (100. n = 264).5%.0%) 0 (0. so the numbers add up to 100% in each column but not across the rows.065* 8. n = 181) or nonprofit organizations (88.1%) 1752 (99.0%) 169 (64.3%) School 181 (62.0%) 264 (100.1%) 18 (2.0%) 41 (23.8%) 292 (16.8%.0%) 178 (10.5%) 291 (33.0%) 264 (100.0%) 863 (49.6%) 1379 (78.455* 330. logos (88.0%)
500.0%) 264 (100. *p < . n = 70).9%. n = 176) than by educational institutions (62.0%) Total 715 (40.9%) 286 (97.550).0%) Hospital 163 (100.4%) 688 (39.0%) 221 (83.0%) 52 (29. p < .0%) 0 (0.9%) 178 (100.724* 1341.5%) 1760 (100.6%) Business 176 (98.0%.0%) 1760 (100.2%) 811 (94.05
The results for RQ4. and health business corporations (98. n = 163).0%) Hospital 163 (100.1%) Nonprofit 282 (32.0%) 264 (15. related to the number of branding/advertising techniques that health organizations used on Facebook.0%) 178 (10.4%) 92 (51.
.0%) 936 (53. n = 1.0%) 0 (0. Logos
were used more frequently by government agencies (100%. These differences were statistically 2 (4.752).3%) School 175 (59.1%) 827 (47.353 110.450*
Notes: The percentages in the cells are column totals. Branding/Advertising Techniques Used by Health Organizations for Promotional and Advertising Purposes in Facebook
Health Organization Feature Logo Photo Bio ad Post ad Ad goal Total Government 264 (100.7%) 0 (0. n = 1.9%) 153 (86. are in Table 3.70
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Table 2. Four degrees of freedom.9%) 234 (80.0%) 0 (0. Social Media Channels Used on Facebook by Health Organizations
Health Organization Application Twitter YouTube Flickr Blog Total Government 0 (0.705* 36.0%) 67 (41.
Table 3.0%) 163 (100.1%.1%) Nonprofit 766 (88.2%) 144 (80.5%) 70 (4. N = 1760) = 267.0%) 163 (100.0%.0%) 163 (9.05. post ads (53.7%) 574 (66. * p < .1%) 139 (85. followed by the presence of advertising goals (90.2%) 1592 (90.8%) 855 (99.5%) 863 (49.0%) 292 (100. An organization's photo (avatar) appeared in nearly all the comments by health organizations (99.3%) 268 (91. n = 936).592).9%) 292 (16.115*
Notes: Four degrees of freedom.1%) 286 (97.
n = 268) and nonprofit organizations (94.3%. or schools/universities (36.2%.
. Advertising goals (i. We have identified and contrasted five types of health organizations on these primary variables. and resources.g.0%. n = 450). In contrast. DISCUSSION Overview This descriptive study examined health organizations' use of interactive features. Nonprofit organizations did not use branding techniques as frequently as the other organizations. The results also indicate that nonprofit health organizations are not taking full advantage of other social media channels available.1%. government agencies. what interactive features were being used.71
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Only 70 bio advertisements were identified among business organizations (29. and the results of chi-square analyses reveal significant differences in the interactive features used. Health care institutions used social media channels more frequently than the other organizations. "purposeful" posts) were least likely to be used among government agencies (83.8%. social media channels. so they focus only on one aspect of Facebook. cannot afford to use the interactive features. None were present in the comments posted by health care organizations. n = 169).05). n = 221).3%. This finding corresponds to previous research indicating that nonprofit organizations and public institutions give consideration to how to integrate interactive elements into their communication planning (Waters 2007). n = 811). health care institutions (41. health business corporations used interactive features least.2%. the lack of use may arise because nonprofits. Specifically. RSS feeds.0%. n = 106). It is plausible to speculate that social media technology is more appealing to public and nonprofit health sectors. Health business corporations appear to approach social media in a more staid. Because schools/universities and health care institutions often have greater resources than nonprofits. we examined who among health organizations used Facebook to promote health issues. student labor) and funding.. Commercial businesses used photosharing and blogging about health literacy less frequently than the other organizations examined. and health business corporations (86. Medical centers and hospitals appeared to strive to leverage their social media efforts by employing various social media channels in combination with Facebook. Nonprofits rarely offered informative videos or links to their social media sites. n = 52) and nonprofit organizations (2. and blogs. including RSS feeds and videosharing. n = 144) had a higher proportion of post ads than government agencies (64. despite their lack of staffing and resources (National Association of County & City Health Officials 2009). and how health organizations used Facebook's branding/advertising techniques to manage their selfpresentation and social presence online. and branding/advertising techniques on Facebook. conservative manner. n = 67). by virtue of having small staffs and budgets. This pattern of results implies that organizations simply may not be aware of these Facebook features (Harbison 2011).9%. Government agencies and schools/universities appeared to undertake the broadest use of the interactive features of any of the organizations examined. and Flickr. n = 139). blogging) into their social media strategies. N = 1760) = 36.0%. such as Twitter. n = 18). which social media channels were used in conjunction with Facebook. video-sharing. YouTube. health care institutions (85. In contrast. As for post advertisements. these groups can exploit other social media in combination and on a wider scale. and approximately five or more times that of business organizations and health care institutions. The same was true of schools/universities. Alternatively.
The photo-sharing function was the only interactive application that nonprofit organizations used for involving the public. Yet the nonprofit organizations did not incorporate a wide array of interactive features (e. social media channels selected. including Twitter.. which can be integrated with Facebook. n = 153) compared with schools/universities (91. and branding techniques applied in Facebook. They had more than double the number of posts compared with schools/universities and government agencies. as an inexpensive but effective way to communicate with target audiences.7%. time.e. nonprofit organizations (51. RESULTS AND IMPLICATIONS Nonprofit organizations were more active in posting to Facebook than any other health organization examined. a chi-square analysis showed that health business corporations (80.1%. which would necessitate additional staffing. health business organizations used Twitter least frequently and did not use Flickr at all. or schools/universities. where visitors of Facebook pages expect to find detailed information about an organization to obtain a better understanding of a health issue. Social media need to be part of a larger strategic communication effort and should not be treated as an "addon" to what marketers are already doing online or offline. according to health organization type.115. p < .. These differences 2 (4. both in personnel (e. YouTube.g.
Business organizations did not take advantage of the interactive features or social media channels offered by Facebook to promote of health literacy. nonprofit organizations and schools/universities primarily dedicated their communication
efforts to increasing health literacy and promoting relevant public services. This result suggests that health organizations put a great deal of effort into making a good impression on visitors and managing their images on social networking sites. it is important to know how to provide feelings of comfort and connection and create greater fluidity with existing social media pages (Tuten 2008). This distinction may help explain why some organizational types made use of Facebook branding techniques. especially in terms of health literacy. New communication technologies can broaden educational opportunities to help people increase their health knowledge and develop appropriate information-seeking skills (Ratzan 2001). may attract more users' attention and help to drive web traffic to organizations' pages. whereas others do not. whereas other organizational types did not. no known techniques currently exist for sampling social media. Their interactive features. but they relied heavily on the use of logos as a branding technique. "Who says What in Which channel to Whom with What effects. such as videos and widgets. and the health literacy gap is a significant topic in health communication (Nutbeam 2000). the Centers for Disease Control and Prevention (CDC) has guidelines on social media use among CDC employees. rather than advertising for monetary benefits. Inasmuch as we are confident in the sample collected (i. such as the use of a logo or avatar. This study also has examined how health organizations made use of branding/advertising techniques. thereby increasing awareness of both the organizations' presence and health literacy issues. Facebook postings by nonprofit organizations and educational institutions rarely included specific brand names but appeared purposeful. the differences among organizations were not significant." to burgeoning social media. This study also offers insights for social media managers. which likely relates to the focus of these organizations' social media marketing. and health care institutions used post advertisements more frequently and thus were more goal-oriented in nature than nonprofit organizations. LIMITATIONS AND FURTHER RESEARCH Despite the great lengths taken to ensure a sound sampling technique. The implication is that some organizations may have established policies on social media participation. potential basis for further research into the effective use of social media tools. These efforts may generate public perceptions that they are attentive and responsive to their Facebook pages and thereby drive more users of social networking sites to their pages through viral marketing (Thackeray and Neiger 2009). Business organizations. Almost all organizations examined uploaded a unique image or photo as an avatar. cross-checks yielded no additional health
. presumably for selfpresentation to manage their image and promote their brands. this descriptive study provides a strong. As an initial attempt to examine the use of social media for health advertising and promotion. Organizations may not need to invest in a plethora of social media sites. Health literacy awareness is low. government agencies. The theoretical significance of this study pertains to the application of the principal model of advertising and communication. All the government agencies and health care institutions examined had their logos on their Facebook pages. Rather.e.. in that it provides a snapshot of health organizations' current use of social media and offers ways to improve their social media practices.72
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whereas nonprofits and schools/universities have more freedom to share information freely and try new approaches. health organizations' use of social media brings benefits to not only themselves but also the public. whereas schools/universities and nonprofit organizations did not actively employ this branding technique. For example. Those with better established policies presumably would do a better job taking advantage of the interactive features on Facebook. Although the use of organizations' photos was not used to the same extent by nonprofits as it was by the other organizations examined. Unlike business corporations. The communication and branding objectives of a health organization can be achieved through strategic planning and the constant evaluation of social media use. Facebook and other social networking sites provide several advantages over other communication channels for achieving organizational goals for health literacy. Social media managers working in the health care sector need to utilize more interactive features and platforms and create an attractive social network identity to connect with more users and build their brand. In these circumstances. such as the rule that every employee who uses Facebook on behalf of the CDC must use a CDC logo. Intertwined with this finding.
which has implications not just for social media sites but potential word of mouth and advertising on social media sites. However. making it impossible to know if the organization uses some features. there was no means by which businesses could leave a comment on their own Facebook page. The use of mobile phones enables consumers to share more content through social media sites. these features are not readily apparent by examining a business's Facebook page. Studies also should examine "likes" and other forms of engagement to assess the value of the social media site for users. Knowing the circumstances in which the use of interactive features. When a health organization uses a specific interactive feature.. now businesses can leave their own comments to be voted on. support response) and engagement data (e. but additional interactive features enhance "liking. the organization uses Facebook settings). but further studies would need to conduct a survey or depth interviews with
. Although we tried to be comprehensive in coding interactive features. However. additional studies must develop tried and true sampling procedures. because they require a level of knowledge and expertise. Nor can we explain why one organizational type uses one feature over another." such as voting on "liked" pages. businesses can send automatic updates to fans. because they rely on commands behind the scenes (i. for example. We assume the features are there to enhance users' experience. can be costly to staff and may limit the types of organizations that can afford such features. social media channels. unlike an everyday citizen as a member of the target audience. fans. and people can click through to a health organization's business page (Harbison 2011). which poses several challenges. but it was difficult to assess this variable for the range of organizations that emerged as part of this analysis. For example.e. Fans might tag themselves in photos. or not. Online tools such as RSS feeds and blogging presumably should work best when used in combination.. Facebook has changed its terminology from "becoming a fan" to "liking" a page. Finally. The increasing role of mobile in driving social media suggests that further studies should examine the unique interactive features. Since April 2010. resonation. and Xu 2010). what combination of interactive features must be present? Additional research is needed to determine which combinations work best under which circumstances and for which organizational type. At the time of the coding. and branding techniques improve or enhance an organization's brand presence in social media sites would help inform theory about psychological processing of these features. likes. and they need to be examined by further studies. it may be that blogs work better for organizations that want to communicate with
other organizations. it also could clarify the practical uses of the many features available in social media sites (Cui. the target audience the health organization wants to reach. and branding techniques in mobile channels. the organizational types examined ground this research on observations of the features used and not used by these particular organizations. Additional research might look at the effects of specific interactive features on Facebook to gain an understanding of consumers' perceptions of their use health organizations. From these results.g. do consumers and potential consumers necessarily see it as a benefit? Consumers' perceptions of the interactivity of social networking sites are a key concern for online health organizations. check-ins). Facebook used the term "fans" to refer those who "liked" the health organization's page and could link to it to receive updates. and the strategic communication goals of the organization. other features remain. We examined the number of fans for this study. and branding/advertising techniques. Wang. The intent is not to draw causal connections but rather to identify what features actually are used.73
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literacy organizations). views. There is also a need to understand these interactive features to develop better social media analytics (e. At the time of the coding. social media channels. followers. share of voice. and businesses can automatically block certain words or terms to control what content gets posted on the organization's Facebook page.g. The phrase change should not alter the meaning of what we coded. which combinations work best for which organizations? If a hospital wants to build credibility on its blog. Time and resources are likely factors. clicks. social media channels. The features we coded were readily apparent and indicated in the postings and organizations' biographical pages. Technology is constantly changing. Feedback systems that use real-time chat. That has changed in the past few weeks. Different methods thus are needed to gain perspective on the types of features that health organizations use behind the scenes to interact with and create relationships with consumers. but we cannot confirm which features or combinations of features have this effect. it seems that the combination of social media and interactive features offered by the channels depends on the type of health organization..
Lauren (2010).emarketer. Twitter.com /press/info. 2010). Halpern. Evans.
Chou. organizations are told to diversify their social media efforts by coordinating social networking applications to satisfy audiences' diverse needs and expectations (Waters et al. "Low Health Literacy and Health Outcomes: An Updated Systematic Review. social media channels. Cui. Nicole.74
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organizations to understand their motives.jmir." Annals of Internal Medicine. Edward J. Social Network Usage: 2011 Demographic and Behavioral Trends. as well as challenges the organizations encounter in establishing a social media presence online. 11 (4). "Social Network Sites: Definition. Tao Wang. "Patients Social Media Use Raises Practical Issues for Doctors. and Nicole B. and Abuse of Content Analysis Research on the Consumer Interest. and Sydney Jones (2009). "Managing Impressions Online: Self-Presentation Processes in the Online Dating Environment. 100-105. as well as the benefits to the organizations and users of social media. and branding tools and widgets makes it easier for organizations and businesses to bring social media content back to their corporate websites.com (accessed January 8. Donahue.com (accessed April 11. 13 (1). Facebook (2011). Sheridan. and Sally J. 155 (2). depending on the social media feature and organizational type examined. Shelley (2009). http://www." Journal of Computer-Mediated Communication.com/Reports/All/Emarketer_2000777.allfacebook. http://www. Downes. CONCLUSION A core strength of social media pertains to its potentially broad appeal. 2 (2)." http://www. Ellison (2008). 2010). The growing number of interactive features. offering a wide array of features. Moser. Dugan.com/fitness-in-portland/facebookfitness-application-fit-ify-health-and-fitness-tracker (accessed October 25. Donohue.org/2009/4/e48/. 42 (1). channels. 2010)..com/facebook-health-applications2010-02 (accessed October 25.S. Anecdotally. 2011). Pamela Lewis (2011. from profiles to instant messaging to news feeds and quizzes to feedback mechanisms (Tuten 2008). The Global Social Media Check-up 2010. Fox.facebook. 36-49. This study shows that the manner in which organizations are doing so varies considerably. 11 (2). "The Influence of Social Presence on Consumers' Perceptions of the Interactivity of Web Sites. "8 Healthy Facebook Applications You Should Use to Stay Fit." Journal of Consumer Affairs.a spx (accessed April 8. "Use Misuse. and Shuang Xu (2010). Ellison. nonprofit organizations or community groups were most inclined to engage actively in posting health information and interacting with the public via Facebook. History. http://www. boyd. Burson-Marsteller (2010). April 1). 157-79. and Other Social Media." Journal of ComputerMediated Communication. "Facebook Fitness Application: Fitify Health and Fitness Tracker." Journal of Medical Internet Research. Susannah. Stacey L. and Karen Crotty (2011)." http://www. 2011). 97-107. Hesse (2009). 2011). Nancy D. Les (2008). "Statistics. Indianapolis: Que Publishing. Hunt. Rebecca Heino." http://www. "Digital Relationships in the Proceedings of the 40th Hawaii International Conference on System Sciences (HICSS)." New Media & Society. "Defining Interactivity. Carlson. 2011). Nan. and Scholarship.examiner. The results of this content analysis indicate that of the health organizations examined. Dolan. 11 (1). David J.profrisk. http://jcmc.indiana. "The Social Life of Health Information. Catherine (2007). Yvonne M. Dwyer.edu/vol11/issue2/ellison.html. and Jennifer Gibbs (2006)." http://www. Social Media Marketing: Strategies for Engaging in Facebook. "Social Media Use in the United States: Implications for Health Communication." http://www." Journal of Interactive Advertising. Katrina E. Richard P. Ellen Burke Beckjord. Liana (2010).burson-marsteller. McMillan (2000). there is much that remains to be understood in terms of the features offered by social media sites and used by organizations. danah M. Wen-ying Sylvia.org (accessed March 2. Although Facebook holds great potential as a communication tool." Pew Internet & American Life Project. January. Hawaii. and branding techniques than health business corporations and medical centers. 210-30.php?statistics (accessed April 8. "U.pewinternet. eMarketer (2011). and Bradford W. Government agencies and educational institutions were more likely to take advantage of social networking features. REFERENCES Berkman. 2009).
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Suggs. 9 (4). E-mail: hpqk3@mail. "The (Potential) Benefits of Campaigning via Social Network Sites. Wang. "Building Brand Relationships Online: A Comparison of Two Interactive Applications. 226-34. 35 (2). "Nonprofit Organizations Use of the Internet: A Content Analysis of Communication Trends on the Internet Sites of the Organizations on the Philanthropy 400. 102-106. http://www. 2011). and community-based health interventions. Carl L. ---.0 World. health communication. Mass Media Research: An Introduction. Inc. and new technology.hrsa. (2008). CA: O'Reilly Media.edu
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(c) Schools or universities Health Sciences Libraries. Learns Make Health Care Right e-Patient Connections Global Health Corps Health Literacy Awareness Health Literacy for All Health Literacy Missouri Health Literacy Month Health Literacy Out Loud Health Technica
. Eccles Health Sciences Library. University of Utah Tufts-Emerson Health Communication University of Wisconsin Department of Family Medicine
(d) Business/corporations/pharmaceutical companies Compass Healthcare Communications H is for Hope Books Health Literacy Innovations Minority Nurse Magazine MS&L Worldwide No Time to Teach PharmaLive
(e) Community/advocacy/nonprofit groups American College of Physicians Foundation Cover Missouri D.77
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APPENDIX. University of Michigan Spencer S.C. List of Organizations (a) Government centers or agencies National Network of Libraries of medicine
Journal of Participatory Medicine Kansas City Nursing News Literacy Assistance Center Literacy Volunteers of New Jersey Minnesota Health Literacy Partnership Missouri Foundation for Health San Diego County Taxpayers Association Wisconsin Literacy World Education Yellin Center
(b) Health care institutions St.
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